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Workers’ Compensation FAQ

I had an accident, and I did not report the accident on the date of accident. I am being told that since I did not report it on the date of accident I am no longer entitled to workers’ compensation benefits.  Is this true?

Answer:  No.  By law you have thirty (30) days to report your accident from the date of accident.  However, it is suggested that you report any accident immediately even if you are not seeking medical treatment right away.

I had an accident and reported it to my employer. I was subsequently terminated from my employment.  Do I still have a workers’ compensation claim?

Answer:  Yes.  Termination of employment does not end your entitlement to receive medical treatment for your injuries.  Additionally, you may still be entitled to indemnity benefits depending upon the reason for termination.

I was terminated from my employment after reporting my claim. Do I also have a claim for being terminated from employment?

Answer:  Possibly.  If you can establish that the termination was because of your workers’ compensation claim, you may have a retaliatory discharge claim.

What types of benefits am I entitled to as a result of my work related accident?

Answer:  You may be entitled to two (2) types of benefits; medical and indemnity.  The medical benefits cover any reasonable and medically necessary medical treatment related to your work related injuries.  This includes doctor visits, testing, surgery, therapy, prescriptions, and transportation costs.  Also if you need assistance at home, you may be entitled to this as well if prescribed by your doctor.  The indemnity benefits are payable if your physician opines that you are unable to work or have work restrictions that your employer cannot accommodate.

My employer is calling me to return to work. Do I have to return to work?

Answer:  If your doctor told you that you cannot work at all, then you do not have to return to work.  You should provide your employer with the work status report of your physician.  If your doctor told you that you can work with certain restrictions, you should only work within those restrictions.  You should provide those restrictions to your employer and keep a copy for yourself.  When you return to work, bring those restrictions with you.  If your supervisor asks you to do work outside those restrictions, show him a copy of your restrictions and advise him that you are willing to perform any duties within those restrictions.  If the problems persist, speak to the human resources director, the claims adjuster and/or your physician.

When can I expect to receive my workers’ compensation checks?

Answer:  Your first check may take up to three (3) weeks to receive.  After that your checks should arrive every two (2) weeks.  If you only miss one week, you are not entitled to a workers’ compensation check.  If you miss two weeks only, you are entitled to one week of indemnity benefits.  If you miss three weeks or more, you are entitled to indemnity benefits for each week out of work pursuant to your doctor’s recommendations.

How much should my workers’ compensation check be?

Answer:  The adjuster should take an average of the thirteen (13) weeks prior to your accident to establish an average weekly wage.  If you are on a no work status, your indemnity check should be 66 2/3% of your average weekly wage.  If you have work restrictions, and your employer cannot accommodate you, then your indemnity check should be 64% of your average weekly wage.

If I am making less money due to doctors’ appointments or a reduction in hours or rate of pay due to the limitations, does the insurance company pay the difference?

Answer:  If you make less than 80% of your average weekly wage during any given week in which you have work restrictions, the insurance company may owe some indemnity benefits.

How do I get medical treatment for my injuries?

Answer:  Once your accident is reported, your employer or their workers’ compensation carrier should authorize a clinic or primary care provider to evaluate you.  If they refuse to authorize a doctor within a reasonable amount of time, you can seek the treatment on your own, and later ask that they pay for this treatment.  However, you must first request medical treatment and provide them a reasonable opportunity to authorize it for you.

What do I do if I have a medical emergency?

Answer:  If you have a true medical emergency, you can seek treatment at the closest hospital or emergency room, and your employer or their workers’ compensation carrier will be responsible for reasonable and medically necessary emergency treatment.

Can I request a change in doctor if I am not satisfied with the doctor that they authorize?

Answer:  Depending on the date of your accident, you may be entitled to a change in doctor.  However, you should know that you may only be entitled to one change in doctor during the course of your treatment so this should be used wisely.

What are some of the reasons why my workers’ compensation check would stop?

Answer:  If your doctor opines that you are at maximum medical improvement or can return to work full duty, your checks could stop.  Also, if your doctor opines that you can work with restrictions, and your employer offers you a job within those restrictions, your checks could stop.  If you are medically non-compliant your checks could stop as well.  Finally, if you have received 260 weeks of temporary indemnity benefits, your checks could stop.

My adjuster sent me some forms to sign and indicated that if I do not return these forms she will terminate my benefits. Can he/she stop my benefits because of this?

Answer:  Yes.  There are certain forms that need to be completed and returned within twenty-one (21) days.  Specifically, you are required to return a fraud statement, an Employee Earnings Report (DWC-19), an Unemployment Release, and a Social Security Disability Information Release.

The adjuster is asking that I sign a medical release. Do I have to sign it?

Answer:  You do not have to sign a blank medical release.  However, the adjuster is entitled to obtain your prior medical records to determine if there are any relevant prior injuries or treatment.  You can ask to sign a medical release that is limited specifically to a particular physician(s) so you know which medical records are being requested.  You should request to receive a copy of any medical records they receive.

The adjuster would like for me to give a recorded statement. Do I have to provide one?

Answer:  There is no statutory requirement to give a recorded statement.  However, it is extremely important that you provide accurate information to your employer, insurance company and your doctors about any and all prior injuries, medical conditions, or accidents regardless of whether they are related to your accident or not.

What are the consequences of failing to provide accurate information to my employer, insurance company or doctor?

Answer:  If you provide any false or misleading statement for the purpose of obtaining benefits, your workers’ compensation benefits can be completely terminated, and you could be charged criminally.  The types of information considered important or relevant for this purpose can include but are not limited to:  (1) a history of any and all prior accidents and injuries regardless of whether you hired an attorney, (2) a history of your prior medical treatment, (3) an accurate representation of your limitations or injuries (such as your use of assistive devices, your physical abilities or activities, etc), and (4) whether or not you are working regardless of whether for your employer, a side job, temporary job, etc.

I have a second job from which I am losing time. Are those earnings taken in account?

Answer:  You may be able to include your earnings from your second or concurrent employment.

How long do I have after my accident to file a claim?

Answer:  You have two (2) years from the date of accident, or one (1) year from the date of last authorized medical treatment or payment of indemnity benefit.  If you believe your time lapsed, you should still consult an attorney to review your case.

If I hire your firm, do I have to pay a retainer or attorney’s fees or costs along the way?

Answer:  No.  My office does not require any sort of monetary retainer, and any attorney’s fees and costs are paid from the settlement proceeds.

How long after I settle the case will I receive my settlement proceeds?

Answer:  Generally this process can take anywhere from four to eight weeks, but each case is different.  Settlement documents have to be drafted, signed by all parties, and approved by the judge of compensation claims before the insurance company forwards the check to my office.